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What 'Good outcome' means to patients : understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective

Melissa De Smet (UGent) , Reitske Meganck (UGent) , Rosa De Geest (UGent) , Ufuoma Angelica Norman (UGent) , Femke Truijens (UGent) and Mattias Desmet (UGent)
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Abstract
This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive- behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients' pre-post outcome scores on the Beck Depression Inventory-II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients' interviews, ultimately resulting in a conceptual model of "good outcome." From patients' perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson-Truax classification of "good outcome" could not account for the (more pessimistic) nuances in outcome experiences, especially for "improved" patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study.
Keywords
psychotherapy outcome research, RCT, patient perspectives, mixed-method, depression, grounded theory, ASSESSING CLINICAL-SIGNIFICANCE, THERAPY, CLIENTS, REMISSION, EVENTS

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MLA
De Smet, Melissa, et al. “What ‘Good Outcome’ Means to Patients : Understanding Recovery and Improvement in Psychotherapy for Major Depression from a Mixed-Methods Perspective.” JOURNAL OF COUNSELING PSYCHOLOGY, vol. 67, no. 1, 2020, pp. 25–39, doi:10.1037/cou0000362.
APA
De Smet, M., Meganck, R., De Geest, R., Norman, U. A., Truijens, F., & Desmet, M. (2020). What “Good outcome” means to patients : understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective. JOURNAL OF COUNSELING PSYCHOLOGY, 67(1), 25–39. https://doi.org/10.1037/cou0000362
Chicago author-date
De Smet, Melissa, Reitske Meganck, Rosa De Geest, Ufuoma Angelica Norman, Femke Truijens, and Mattias Desmet. 2020. “What ‘Good Outcome’ Means to Patients : Understanding Recovery and Improvement in Psychotherapy for Major Depression from a Mixed-Methods Perspective.” JOURNAL OF COUNSELING PSYCHOLOGY 67 (1): 25–39. https://doi.org/10.1037/cou0000362.
Chicago author-date (all authors)
De Smet, Melissa, Reitske Meganck, Rosa De Geest, Ufuoma Angelica Norman, Femke Truijens, and Mattias Desmet. 2020. “What ‘Good Outcome’ Means to Patients : Understanding Recovery and Improvement in Psychotherapy for Major Depression from a Mixed-Methods Perspective.” JOURNAL OF COUNSELING PSYCHOLOGY 67 (1): 25–39. doi:10.1037/cou0000362.
Vancouver
1.
De Smet M, Meganck R, De Geest R, Norman UA, Truijens F, Desmet M. What “Good outcome” means to patients : understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective. JOURNAL OF COUNSELING PSYCHOLOGY. 2020;67(1):25–39.
IEEE
[1]
M. De Smet, R. Meganck, R. De Geest, U. A. Norman, F. Truijens, and M. Desmet, “What ‘Good outcome’ means to patients : understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective,” JOURNAL OF COUNSELING PSYCHOLOGY, vol. 67, no. 1, pp. 25–39, 2020.
@article{8624029,
  abstract     = {This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive- behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients' pre-post outcome scores on the Beck Depression Inventory-II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients' interviews, ultimately resulting in a conceptual model of "good outcome." From patients' perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson-Truax classification of "good outcome" could not account for the (more pessimistic) nuances in outcome experiences, especially for "improved" patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study.},
  author       = {De Smet, Melissa and Meganck, Reitske and De Geest, Rosa and Norman, Ufuoma Angelica and Truijens, Femke and Desmet, Mattias},
  issn         = {0022-0167},
  journal      = {JOURNAL OF COUNSELING PSYCHOLOGY},
  keywords     = {psychotherapy outcome research,RCT,patient perspectives,mixed-method,depression,grounded theory,ASSESSING CLINICAL-SIGNIFICANCE,THERAPY,CLIENTS,REMISSION,EVENTS},
  language     = {eng},
  number       = {1},
  pages        = {25--39},
  title        = {What 'Good outcome' means to patients : understanding recovery and improvement in psychotherapy for major depression from a mixed-methods perspective},
  url          = {http://dx.doi.org/10.1037/cou0000362},
  volume       = {67},
  year         = {2020},
}

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